Raine brings a rich harvest for science

Changing our view of health — some of the key findings of the long-standing Raine Study.

Professor John Newnham — King Edward Memorial Hospital — obstetrics

Findings have influenced clinical practice world-wide:

There is no additional benefit in doing repeated ultrasound scans from mid-pregnancy onwards in the absence of a clinical indication. The Raine Study ended the debate in the early 1990s on whether every antenatal visit should include a scan and led to the practice of a routine scan for all pregnant women at 18 weeks gestation, with further scans ordered for a clinical indication.

The Raine Study, with follow-up into adulthood, has provided the world’s best evidence for the long-term safety of repeated ultrasound scans in pregnancy.

In addition: The foetal growth curves that we developed using these WA data remain in use as the clinical standard for growth in the womb during pregnancy in WA.

Professor Wendy Oddy — Telethon Kids Institute — nutrition

Earlier introduction of milk other than breast milk (formula milk) was associated with greater development of asthma and asthma severity in children at five years of age.

Eating a more Western dietary pattern (more take-away, soft drinks, processed foods etc) led to greater levels of obesity and fatty liver disease and more mental-health problems in teenagers.

Greater intake of soft drinks was associated with greater levels of obesity in teens.

More intake of “energy drinks” led to greater levels of mental-health problems in young adults.

Language delay in early childhood is associated with lower maternal vitamin D levels during pregnancy and higher prenatal testosterone exposure.

Dr Seyan Yazar — Lions Eye Institute — ophthalmology

With the Raine Study as part of international collaborative team, we identified genes that play a role in many eye diseases.

Outdoor time is thought to be protective against short-sightedness (myopia), particularly in children. We found a link between short-sightedness and lower vitamin D levels in young adults. Vitamin D may play a role in short-sightedness, as outdoor sun exposure is the main source of vitamin D production.

Professor Rob Eikelboom — Ear Science Australia — otolaryngology

One in four Australian children will experience recurrent ear infections (known as otitis media) at the age of three. Children with allergies, older siblings, those who attend day care and who did not have exclusive breastfeeding for at least four months are at a higher risk of developing ear disease.

A study of the Raine Study children when aged 5 to 7 years suggests that current recommended referral criteria may require reconsideration along with effects of age and time of year. This study has the potential to impact on clinical services and childhood hearing screening guidelines.

Men assessed at age 21 who had good growth in utero tended to have better sperm counts than those who had poor foetal growth. Men exposed to their mother’s smoking habit while she was pregnant had lower sperm counts in adulthood, and men who had slower growth or who were overweight through adolescence tended to have lower sperm counts in adulthood.

Girls who were exposed in utero to their mother’s smoking habit had a smaller uterus in adolescence.

Increasing bodyweight and lifestyle-related health behaviours such as high salt intake and low physical activity are associated with increased blood pressure in adolescents.

Consumption of alcohol in boys and oral contraceptive use in girls are important factors that are associated with increased blood pressure.

Exposure to passive smoking from birth to adolescence is associated with reduced HDL cholesterol (the “good” cholesterol) in adolescent girls but not boys.

Exposure to life stress for mothers during pregnancy, particularly financial or marital problems, is associated with increased weight but lower blood pressure, in their children at 20 years of age. This shows that events during pregnancy can have long-lasting effects on children.

Assoc Professor Rae Chi Huang — Telethon Kids Institute — obesity

Obesity-related disease affects many children, with 29 per cent at risk at age 14.

Professor Graham Hall — Telethon Kids Institute — asthma

Allergy, the inappropriate immune response to an otherwise harmless substance, was an important risk factor for having asthma at age 14. Eighty per cent of 140 asthmatic teens had an allergy, with the most common allergy being to house dust mite and rye grass pollen.

As well as being good for our bones, vitamin D is needed to regulate our immune system. We found that many Raine Study six and 14-year-olds did not have the recommended vitamin D levels, especially in winter. At both ages, children (particularly boys) with low vitamin D were more likely to have allergies, and boys with low vitamin D levels were more likely to have asthma and allergy at age 14.

Dr Monique Robinson — Telethon Kids Institute — mental health

The Raine Study has looked at the effect of issues during pregnancy on the child’s likelihood of developing a mental-health problem. Previously, it was thought mental health was only influenced by things that happened later in childhood but knowing we can intervene in pregnancy is a very exciting discovery.

Factors during pregnancy that can affect a child’s mental health include the mother smoking in pregnancy, being overweight, having low vitamin D and the mother’s age as well as obstetric complications.

Social disadvantage in pregnancy and early in the child’s life — for example low family income, low maternal education level and high stress — was one of the most important factors in the child’s risk for later mental-health problems.

Dr Karina Allen — Telethon Kids Institute — eating disorders

About 3 per cent of boys and 15 per cent of girls will experience an eating disorder by age 20.

Being female, being thought of as overweight by one’s parents and concerns about eating, weight and shape were the strongest predictors of eating disorder risk.

Teenagers with an eating disorder at age 14 who are still engaging in purging behaviours at age 17, as well as teenagers with high levels of “acting out” or rule-breaking behaviour at age 14, are most at risk for continuing to have eating problems into adulthood.

Professor Peter O’Sullivan — Curtin University — spinal pain

Back pain, particularly if long-lasting, has a significant negative impact in adolescence and is associated with disability, care-seeking, medication use, school absenteeism and reduced quality of life.

Teenagers with more negative beliefs about back pain and its future consequences were more likely to be disabled as a result of back pain.

There are different groups of teenagers with spinal pain — in some groups spinal pain co-occurs with mental-health problems and in others it’s more related to physical factors such as exercise and activity levels.

Standing spinal posture in teenagers can be subgrouped into different types, with those teenagers who have a less “neutral” posture more likely to experience back pain.

Childhood obesity can influence standing posture, leading to a greater arching of the lower back which is linked to back pain.

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Health+Medicine is supported by a grant from Healthway (the WA Health Promotion Foundation) with the involvement of The National Heart Foundation (WA division), Cancer Council of WA, Asthma Foundation of WA, Australian Medical Association (WA), Telethon Institute for Child Health Research, FPWA Sexual Health Services, School of Population Health University of WA, Arthritis & Osteoporosis Foundation of WA and Diabetes WA.